Educating about food and exercise behaviors
The order in which we teach things does matter. As diabetes educators we see that our patients easily become overwhelmed with caring for their type 2 diabetes, especially when they are newly diagnosed. They need to learn the logistics of caring for their diabetes every day, including checking blood sugars, treating lows and highs, and managing medications. When educating about food and exercise behaviors, if we address exercise first, we may ultimately have more luck in improving both.
I have seen in practice that eating properly and exercising for optimal blood sugar control go hand in hand, when people focus on doing something positive for their body. If a person only thinks in terms of what they cannot do because they have diabetes, then that will be their reality. As diabetes educators, I am sure that you, like me, often encounter people coming to the appointment after their diagnosis with the preconceived thought that we are going to put them on a "diabetes diet" and they are no longer going to be "allowed" to ever have ________ (fill in the blank). Our goal of teaching patients to consume everything in moderation has already been sabotaged by that thinking, so we are not starting from a place of neutral thinking, we are starting from a place of negative thinking. Have you ever realized, after a patient has left your office, that you spent time convincing them that they can eat a certain food in moderation? We usually do this because we know that they will end up overeating that food when they experience a low, or as a coping mechanism for their unexplored emotions. So we work hard to help them understand that they need to give themselves permission to eat certain foods as part of a healthy diabetes lifestyle—foods that society, or a friend or family member, has told them were off limits.
And here is where exercise fits in. Positioning exercise as an important part of the initial discussion will help reset the preconceived negative thoughts back to neutral. When the positive results of exercise are observed personally, patients stop thinking about what they have to give up, and instead think in terms of what they need to do to nourish and properly fuel their body.
Most patients who are diagnosed with diabetes already know that they need to improve their diet and limit their carbohydrates (and sugar). They may not know all the foods that contain carbohydrates, but they do have a good idea, and that discussion, while very, very important, will have a greater impact when they relearn how to think about the "what" and the "why" of feeding their body. What your patient begins to learn as they become more active is that eating healthfully is an additional positive action that helps them feel better. A discussion of exercise and its role in diabetes treatment will help your patient understand the benefits, and then when they add physical activity to their daily routine, they will experience it firsthand.
Like eating well, most people know that exercise is good for them. But unlike eating, many people do not enjoy exercise. Here again is a great opportunity to reframe physical activity for our patients. Remind them that they most likely used to enjoy it when they were young, and find out what they like to do. Our goal is to get the body up off the couch or out of the office chair at regular intervals and to add physical movement for burning calories and utilizing glycogen stores into the day.
Movement feels good when it is done properly. If someone has had an injury or a negative experience, a physical therapist, qualified personal trainer or certified Pilate's instructor will be necessary to work with the injury and prevent further injury. There is always something that someone can do to move their body, even if it needs to be a seated exercise (https://www.youtube.com/watch?v=je4NYlKAFRQ) or a supported exercise in the water or on a stationary bike. Explain to your patients that taking a brisk walk, gardening, dancing, fencing, swimming laps, working out with an exercise video (https://www.youtube.com/user/GLUCOSEZONE), or playing a team sport with friends are all beneficial activities that will help them meet the physical activity needs of being a human being. If they like working out at a gym, great! But if they don't, then encourage them to find another activity. And you will begin to notice that being active will influence their food choices, so that they are now asking questions of you on how to make positive changes in their food choices and requesting recipes so they don't "undo" all the good that they are experiencing as a result of their exercise.
So my suggestion is to just try this new order and put the focus on exercise first. Explain to your patients the importance of exercise for treating type 2 diabetes in terms of lowering blood sugars, decreasing body weight, and improving their cardiovascular risk factors. Increasing their activity will help them feel good about themselves in terms of taking care of their diabetes and making positive strides towards improving their overall health. Caution them against thinking that because they exercised, they have license to eat more food and remind them to always be prepared for dealing with highs and lows during physical activity. By paying attention to how they feel as a physically active person, they will be empowered to make healthier food choices and not feel as if that is a punishment but rather a natural extension of the new healthy behaviors of someone who just happens to have type 2 diabetes.
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